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ZHS-19078-37538

3 vaccinations 5 coded responses 38 check-ins 5 free-text entries 3 call cases
Sex
Female
Age at first dose
36-40
ZIP prefix
522 / IA
Registered
2021-03-14
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
5RN-45217-36231 Child or adolescent in my care · Male · 2021-11-06

Timeline

  1. 2021-03-13
    Dose 1 — Pfizer-BioNTech
  2. 2021-03-14
    Registered in v-safe
  3. 2021-03-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Swelling · Fatigue or tiredness
    Adult check-in
  4. 2021-03-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  5. 2021-03-16
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  6. 2021-03-17
    Survey response — days 1–6 daily, dose 1
    MedDRA: Condition aggravated, Inflammation, Mouth ulceration, Pre-existing disease — Feeling: Fair · Fatigue or tiredness
    Free text: autoimmune illness flareup, including oral ulcersinflammatory response may or may not be related to vaccination
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-03-18
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  8. 2021-03-20
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-03-27
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-04-03
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-04-05
    Dose 2 — Pfizer-BioNTech
  12. 2021-04-05
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-04-06
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  14. 2021-04-07
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea
    Adult check-in
  15. 2021-04-08
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Headache, Fatigue or tiredness
    Adult check-in
  16. 2021-04-09
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  17. 2021-04-10
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-04-11
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-04-12
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-04-19
    Survey response — day 14, dose 2
    MedDRA: Heavy menstrual bleeding, Hormone level abnormal, Vaginal haemorrhage — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: My period was abnormal: much heavier than usual with additional days of spotting, plus atypical & very extreme mental health symptoms. Best guess from my doc and therapist was the vaccination/inflammation after the shot affected my hormones.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-04-19
    Report sent to call center — day 14, dose 2
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  22. 2021-04-26
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-05-03
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-05-10
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-17
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-07-05
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-10-04
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-10-22
    Dose 3 — Pfizer-BioNTech
  29. 2021-10-22
    Health check-in — day 0, dose 3
    Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  30. 2021-10-23
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  31. 2021-10-24
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea
    Adult check-in
  32. 2021-10-25
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain, Redness, Swelling, Itching · None
    Adult check-in
  33. 2021-10-26
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain, Swelling, Itching · None
    Adult check-in
  34. 2021-10-27
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · None
    Adult check-in
  35. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  36. 2021-10-29
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  37. 2021-11-05
    Survey response — day 14, dose 3
    MedDRA: Menstrual disorder, Menstruation delayed, Premenstrual syndrome, Reaction to previous exposure to any vaccine — Feeling: Fair
    Free text: My menstrual cycle has been impacted, I believe by the shot because the second shot affected my cycle as well. Various pre-menstrual symptoms are much more intense than my norm and my period is late. (100% no chance that I'm pregnant.)
    MedDRA releases: 2024-11 · check-in free text available
  38. 2021-11-12
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  39. 2021-11-19
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  40. 2021-11-26
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  41. 2021-12-03
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  42. 2022-01-21
    Survey response — 3 months, dose 3
    MedDRA: COVID-19 — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: I currently have lab-verified COVID.
    MedDRA releases: 2024-11 · check-in free text available
  43. 2022-01-21
    Report sent to call center — 3 months, dose 3
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  44. 2022-01-24
  45. 2022-04-22
    Survey response — 6 months, dose 3
    MedDRA: COVID-19, Office visit, Renal impairment, SARS-CoV-2 test positive — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit
    Free text: Symptoms: My kidney function has dropped, directly related to COVID. I have had COVID twice since January (PCR-confirmed in January, antigen test in April). I go in next week for more labs to see if my kidney function is rebounding. · Healthcare visit (other): lab visit for blood work
    MedDRA releases: 2024-11 · check-in free text available
  46. 2022-04-22
    Report sent to call center — 6 months, dose 3
    Get care from a doctor or other healthcare professional
    Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
  47. 2022-04-25

Vaccinations

DoseDateManufacturerCo-administered
12021-03-13Pfizer-BioNTech
22021-04-05Pfizer-BioNTech
32021-10-22Pfizer-BioNTech No

Call center

ReportedOutcomeVAERS-related outcome
2021-04-19 Unsuccessful
2022-01-21 Unsuccessful
2022-04-22 Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-17

Systemic reaction (other): autoimmune illness flareup, including oral ulcersinflammatory response may or may not be related to vaccination

Release 7 — day 14, dose 2

2021-04-19

Symptoms: My period was abnormal: much heavier than usual with additional days of spotting, plus atypical & very extreme mental health symptoms. Best guess from my doc and therapist was the vaccination/inflammation after the shot affected my hormones.

Release 10 — day 14, dose 3

2021-11-05

Symptoms: My menstrual cycle has been impacted, I believe by the shot because the second shot affected my cycle as well. Various pre-menstrual symptoms are much more intense than my norm and my period is late. (100% no chance that I'm pregnant.)

Release 11 — 3 months, dose 3

2022-01-21

Symptoms: I currently have lab-verified COVID.

Release 11 — 6 months, dose 3

2022-04-22

Symptoms: My kidney function has dropped, directly related to COVID. I have had COVID twice since January (PCR-confirmed in January, antigen test in April). I go in next week for more labs to see if my kidney function is rebounding.
Healthcare visit (other): lab visit for blood work

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

FieldPreferred term2021-092023-042024-11
HCVOOffice visit · · ✓
SDCOVID-19 · · ✓
SDHeavy menstrual bleeding ✓ ✓ ✓
SDHormone level abnormal ✓ ✓ ✓
SDMenstrual disorder · · ✓
SDMenstruation delayed · · ✓
SDPremenstrual syndrome · · ✓
SDReaction to previous exposure to any vaccine · · ✓
SDRenal impairment · · ✓
SDSARS-CoV-2 test positive · · ✓
SDVaginal haemorrhage ✓ ✓ ✓
SROCondition aggravated ✓ ✓ ✓
SROInflammation ✓ ✓ ✓
SROMouth ulceration ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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